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This study investigated parents' and siblings' knowledge use during naturalistic teaching episodes in the home. Thirty-seven middle-class families were observed for six 90-minute sessions (siblings aged 4 and 6 years). Parent and sibling teaching sequences were coded for knowledge type (conceptual, procedural), conceptual subcategories (social conventional behavior; game discussions; academic concepts; problem solving) and procedural knowledge subcategories (game procedures; general skill procedures). Research Findings: Findings indicated no significant mean difference between mothers' and fathers' and older and younger siblings' conceptual and procedural teaching. However, parents taught proportionally more conceptual knowledge than siblings, indicating that siblings taught proportionally more procedural knowledge compared to parents. In terms of conceptual subcategories, parents taught more social conventional behaviors, whereas siblings taught more academic concepts. Siblings also taught more general skill procedures compared to parents. Practice or Policy: Overall, our findings indicate that the home environment is a rich context for the naturalistic teaching of conceptual and procedural knowledge by both parents and siblings, thus advancing our understanding of the role of family dynamics on children's learning and development.

Research on enacted stigma, or stigma- and bias-based victimization, including bullying and harassment, among lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth often focuses on one context (e.g., school) or one form (e.g., bullying or microaggressions), which limits our understanding of these experiences. We conducted qualitative go-along interviews with 66 LGBTQ adolescents (14-19 years) in urban, suburban, town, and rural locations in the United States and Canada identified through purposive and snowball sampling. Forty-six participants (70%) described at least one instance of enacted stigma. Three primary themes emerged: (1) enacted stigma occurred in many contexts; (2) enacted stigma restricted movement; and (3) second-hand accounts of enacted stigma shaped perceptions of safety. Efforts to improve well-being among LGBTQ youth must address the diverse forms and contexts of enacted stigma that youth experience, which limit freedom of movement and potential access to opportunities that encourage positive youth development. School nurses can play a critical role in reducing enacted stigma in schools and in collaboration with community partners.

Maternal and paternal teaching sequences directed to their preschool children in a naturalistic home environment were investigated. The sample included 37 middle-class sibling dyads, aged four and six, and both their mothers and fathers during ongoing interactions in the home for six 90-minute sessions. Sequences of parent-child teaching were identified and coded for teacher and learner roles, teaching strategies, child response, and context (e.g., games, conflict). Mothers and fathers did not differ in the overall proportion of their teaching. However, fathers taught significantly more in the game context than mothers, whereas mothers taught significantly more during conflicts. Directive teaching strategies were most commonly employed by parents; the only difference in parental teaching strategies was that mothers were more likely to use explanations compared to fathers. Further, parental differences in teaching initiation, sophisticated versus nonsophisticated teaching strategies, and children's responses were examined. Findings are discussed in light of theory on teaching and learning.

Go-along interviews, which are interviews conducted while being in and moving within participant selected spaces, were conducted with 66 lesbian, gay, bisexual, transgender, and queer adolescents (14-19 years old) in their self-identified communities to explore perceived community attributes, including safe spaces, resources, and supports; this article highlights methodological lessons learned. Successful recruitment in 2 countries and varied community settings required partnership with local lesbian, gay, bisexual, transgender, and queer supporting agencies, including school-based gay--straight alliances. Youth chose to walk, use public transportation, and drive to community locations, identifying numerous formal and informal resources in their communities. Participant reflections highlighted that go-along interviews can be conducted in safe ways that encourage lesbian, gay, bisexual, transgender, and queer youth to express themselves about communities in which they live, study, work, play, and relax.

Naturalistic dyadic sequences of teaching and learning involving older and younger siblings were investigated in 39 middle-class dyads over a 2-year period in early childhood. Siblings were observed during ongoing interactions in the home setting for 6 90-min sessions at both Time 1 (older sibling "M" age = 4.4 years; younger sibling "M" age = 2.4 years) and Time 2 (older sibling "M" age = 6.3 years; younger sibling "M" age = 4.4 years). Sequences of sibling-directed teaching (T1 "n" = 353; T2 "n" = 1,039) were identified from the observation transcripts and coded for teacher/learner roles, initiation of teaching, teaching strategies, and learner response. Older siblings were more likely to engage in teaching at both time points, but the proportion of younger sibling teaching increased significantly from T1 to T2, partially because older siblings requested teaching more often from their younger siblings at T2. Siblings' use of teaching strategies varied across time points, while both older and younger sibling learners generally accepted or complied with the teaching. A final set of analyses examined birth-order effects while controlling for age by comparing older sibling teachers at age 4 (T1) to younger sibling teachers at age 4 (T2). At T1 firstborn older siblings (age 4) engaged in a wider range and more sophisticated teaching strategies than secondborn younger siblings (age 4) at T2. Findings highlight the bidirectional nature of teacher-learner interactions and are discussed in light of recent theory and research indicating that the sibling relationship is a rich context for children's learning and development.

This study examined siblings' knowledge about the teaching concept during naturalistic teaching contexts, wherein children's communicative interactions were used as a gateway to their social understanding (Turnbull, Carpendale, & Racine, 2009). Participants included 39 sibling dyads (older age group, M[subscript age] = 6;4; younger age group, M[subscript age] = 4;5) observed for six 90-min sessions at home. Teaching episodes were identified and coded for: a) initiation of teaching (i.e., assumes role or learner requests teaching), b) knowledge states (i.e., knowledge, lack of knowledge, questioning knowledge), c) transfer of knowledge (i.e., learning), and d) teaching strategies (e.g., direct instruction). Children who assumed the teaching role referenced knowledge and questioning knowledge, whereas learners requested teaching by referencing a lack of knowledge. Firstborn learners were more likely to reference knowledge versus second-born learners who referenced a lack of knowledge. Transfer of knowledge occurred when teachers referenced knowledge. When learners referenced knowledge states, teachers were more likely to use direct instruction, demonstration, and negative feedback. Results underscore the developmental significance of sibling teaching and demonstrate a novel approach to studying children's social understanding in the teaching context (Turnbull et al., 2009).

Social-constructivist models of learning highlight that cognitive development is embedded within the context of social relationships characterized by closeness and intimacy (Vygotsky, 1978). Therefore, in contrast to prior research employing semistructured paradigms, naturalistic sibling-directed teaching was examined during ongoing interactions at home. Thirty-nine middle-class, two-parent families (older sibling, M[subscript age] = 6;3; younger sibling, M[subscript age] = 4;4) were studied. Intentional sequences of sibling-directed teaching were coded for: a) frequency; b) type of knowledge taught (i.e., conceptual or procedural); c) initiation of teaching by the teacher or following a request by the learner; d) teaching strategies (e.g., direct instruction, demonstration); and e) learner responses (e.g., active involvement, rejection). Findings indicated that teachers were most likely to initiate teaching spontaneously rather than respond to direct requests by learners. Teachers were most likely to initiate teaching of procedural knowledge, while learners were most likely to request the teaching of conceptual knowledge. The type of teaching strategy employed depended on who initiated the teaching and the type of knowledge taught. The response of the learner was associated with who initiated the teaching and the teaching strategies employed. These findings reveal the nuances and sophistication of young children's attempts to teach one another naturally in their homes. Findings are discussed in light of recent empirical and theoretical work.

Focused cardiac ultrasound (FoCUS) is becoming standard practice in a wide spectrum of clinical settings. There is limited data evaluating the real-world use of FoCUS with artificial intelligence (AI). Our objective was to determine the accuracy of FoCUS AI-assisted left ventricular ejection fraction (LVEF) assessment and compare its accuracy between novice and experienced users. In this prospective, multicentre study, participants requiring a transthoracic echocardiogram (TTE) were recruited to have a FoCUS done by a novice or experienced user. The AI-assisted device calculated LVEF at the bedside, which was subsequently compared to TTE. 449 participants were enrolled with 424 studies included in the final analysis. The overall intraclass coefficient was 0.904, and 0.921 in the novice (n = 208) and 0.845 in the experienced (n = 216) cohorts. There was a significant bias of 0.73% towards TTE (p = 0.005) with a level of agreement of 11.2%. Categorical grading of LVEF severity had excellent agreement to TTE (weighted kappa = 0.83). The area under the curve (AUC) was 0.98 for identifying an abnormal LVEF (<50%) with a sensitivity of 92.8%, specificity of 92.3%, negative predictive value (NPV) of 0.97 and a positive predictive value (PPV) of 0.83. In identifying severe dysfunction (<30%) the AUC was 0.99 with a sensitivity of 78.1%, specificity of 98.0%, NPV of 0.98 and PPV of 0.76. Here we report that FoCUS AI-assisted LVEF assessments provide highly reproducible LVEF estimations in comparison to formal TTE. This finding was consistent among senior and novice echocardiographers suggesting applicability in a variety of clinical settings. [ABSTRACT FROM AUTHOR]

Proper delineation of both target volumes and organs at risk is a crucial step in the radiation therapy workflow. This process is normally carried out manually by medical doctors, hence demanding timewise. To improve efficiency, auto-contouring methods have been proposed. We assessed a specific commercial software to investigate its impact on the radiotherapy workflow on four specific disease sites: head and neck, prostate, breast, and rectum. For the present study, we used a commercial deep learning-based auto-segmentation software, namely Limbus Contour (LC), Version 1.5.0 (Limbus AI Inc., Regina, SK, Canada). The software uses deep convolutional neural network models based on a U-net architecture, specific for each structure. Manual and automatic segmentation were compared on disease-specific organs at risk. Contouring time, geometrical performance (volume variation, Dice Similarity Coefficient—DSC, and center of mass shift), and dosimetric impact (DVH differences) were evaluated. With respect to time savings, the maximum advantage was seen in the setting of head and neck cancer with a 65%-time reduction. The average DSC was 0.72. The best agreement was found for lungs. Good results were highlighted for bladder, heart, and femoral heads. The most relevant dosimetric difference was in the rectal cancer case, where the mean volume covered by the 45 Gy isodose was 10.4 cm3 for manual contouring and 289.4 cm3 for automatic segmentation. Automatic contouring was able to significantly reduce the time required in the procedure, simplifying the workflow, and reducing interobserver variability. Its implementation was able to improve the radiation therapy workflow in our department. [ABSTRACT FROM AUTHOR]

Background and Aims Although sexual orientation-related alcohol use disparities are well established, researchers have not identified whether disparities are diminishing as societal attitudes towards lesbian/gay and bisexual (LGB) people become more accepting. We examined changes in four alcohol-related disparities between heterosexual and LGB youth from 1998 to 2013 by (1) estimating the prevalence of these behaviors; (2) estimating disparities in alcohol-related outcomes between heterosexual and LGB youth within each wave year; and (3) testing whether the degree of difference in alcohol-related disparities between heterosexual and LGB youth has changed. Design Logistic regression models and year × sexual orientation interactions with repeated, cross-sectional, provincially representative data. Setting British Columbia, Canada. Participants Students (ages 12-19) from the 1998 ( n = 22 858), 2003 ( n = 29 323), 2008 ( n = 25 254) and 2013 ( n = 21 938) British Columbia Adolescent Health Survey (total n = 99 373, 48.7% male, mean age = 14.84). Measurements We modeled age-adjusted differences in life-time alcohol use, age of onset, past 30-day drinking and past 30-day heavy episodic drinking between heterosexual and three subgroups of sexual minority youth (i.e. mostly heterosexual, bisexual and lesbian/gay). Findings Generally, alcohol use declined for all youth, although less so among LGB youth [average adjusted odds ratio (aOR) = 0.58 and aOR = 0.53 for heterosexual males and females and aOR = 0.71 and aOR = 0.57 for sexual minority males and females, respectively). Within-year comparisons demonstrated elevated rates of alcohol use among LGB compared with heterosexual youth for each of the four survey years, especially among females. Findings indicate few changes over time; however, results show an increase in risky alcohol use from 1998 to 2013 among mostly heterosexual (aOR = 1.58 for life-time alcohol use, aOR = 1.58 for 30-day alcohol use and aOR = 1.34 for 30-day heavy episodic drinking), and bisexual (aOR = 1.95 for life-time alcohol use) females. Conclusion Despite the general decline in the prevalence of alcohol use among young people in Canada since 1998, lesbian/gay and bisexual youth in Canada continue to show elevated rates of alcohol use compared with heterosexual youth. [ABSTRACT FROM AUTHOR]

Attention toward who can use which gender binary, multi-stall bathroom has brought to the forefront, once again, the ways in which youth are supported or marginalized. No study has documented sexual and gender minority youths' experiences with and perspectives about bathrooms. We collected qualitative data in 2014-2015. Participants were 25 lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth, aged 14-19, in the United States and Canada. Their comments describe first- and second-hand bathroom experiences, identify advocacy efforts, and highlight the roles of peers and adults in making bathrooms safe (or not). Youth emphasized the importance of gender-neutral bathrooms in fostering a sense of safety and inclusivity. Adult support and gay-straight alliances (GSAs) were important contributors to a welcoming environment and fostered advocacy efforts for gender-neutral bathrooms. We encourage purposeful inclusivity of youths' voices when enacting bathroom-specific policies and legislation that directly influence their health and well-being. [ABSTRACT FROM AUTHOR]

The Macondo oil spill in the Gulf of Mexico has spurred renewed global interest in the regulation of offshore oil and gas exploration, particularly in deepwater areas. At the same time, many jurisdictions are experimenting with strategic environmental assessment ( SEA) processes to fill gaps in more traditional project-based decision-making processes. This article explores the potential of SEA to enhance decision making for exploration in deepwater environments. It does so by examining the experience with SEAs on the east coast of Canada, and applying the lessons learned to the Beaufort Sea. By looking at the issue in two very different environments, we can draw lessons that may also apply to deepwater exploration elsewhere. [ABSTRACT FROM AUTHOR]

This study compares outcomes and immune reconstitution in patients with severe combined immune deficiency (SCID) whose bone marrow transplantation (BMT) was from HLA-identical donor (RID), HLA-matched unrelated donors (MUD), or HLA-mismatched related donors (MMRD). The retrospective study analyzed medical records of infants from Canada and Italy. Outcomes were measured by survival and graft failure, the incidence of graft-versus-host disease, and other complications. Data suggests that MUD BMT could have better outcomes than MMRD BMT when identical HLA is not available.

Introduction: Social emergency medicine (EM) is an emerging field that examines the intersection of emergency care and social factors that influence health outcomes. We conducted a scoping review to explore the breadth and content of existing research pertaining to social EM to identify potential areas where future social EM research efforts should be directed., Methods: We conducted a comprehensive PubMed search using Medical Subject Heading terms and phrases pertaining to social EM topic areas (e.g., "homelessness," "housing instability") based on previously published expert consensus. For searches that yielded fewer than 100 total publications, we used the PubMed "similar publications" tool to expand the search and ensure no relevant publications were missed. Studies were independently abstracted by two investigators and classified as relevant if they were conducted in US or Canadian emergency departments (ED). We classified relevant publications by study design type (observational or interventional research, systematic review, or commentary), publication site, and year. Discrepancies in relevant publications or classification were reviewed by a third investigator., Results: Our search strategy yielded 1,571 publications, of which 590 (38%) were relevant to social EM; among relevant publications, 58 (10%) were interventional studies, 410 (69%) were observational studies, 26 (4%) were systematic reviews, and 96 (16%) were commentaries. The majority (68%) of studies were published between 2010-2020. Firearm research and lesbian, gay, bisexual, transgender, and queer (LGBTQ) health research in particular grew rapidly over the last five years. The human trafficking topic area had the highest percentage (21%) of interventional studies. A significant portion of publications -- as high as 42% in the firearm violence topic area - included observational data or interventions related to children or the pediatric ED. Areas with more search results often included many publications describing disparities known to predispose ED patients to adverse outcomes (e.g., socioeconomic or racial disparities), or the influence of social determinants on ED utilization., Conclusion: Social emergency medicine research has been growing over the past 10 years, although areas such as firearm violence and LGBTQ health have had more research activity than other topics. The field would benefit from a consensus-driven research agenda.